Provider Demographics
NPI:1619431863
Name:MENDEZ GONZALEZ, WANDA M (MS)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:M
Last Name:MENDEZ GONZALEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 AVE NOEL ESTRADA
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3275
Mailing Address - Country:US
Mailing Address - Phone:787-669-3815
Mailing Address - Fax:
Practice Address - Street 1:300 AVE NOEL ESTRADA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3275
Practice Address - Country:US
Practice Address - Phone:787-669-3815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6239103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling